Ejaculation preserving Laservaporesection of the Prostate using a 2μm Thulium Laser in endoscopic surgery – Outcome and demonstration of a new surgical technique
Christoph Lang, Department of Urology, Knappschaftskrankenhaus Sulzbach, Germany
Younis AlBulushi, Department of Urology, Städtisches Klinikum Neunkirchen, Germany
Robert Eichel, Urological Outpatient Clinic, Neunkirchen, Germany
Saladin Alloussi, Department of Urology, Städtisches Klinikum Neunkirchen, Germany
Schahnaz Alloussi, Department of Urology, Städtisches Klinikum Neunkirchen, Germany
Introduction and Objectivs:
To evaluate the feasibility and outcome of ejaculation preserving Laservaporesection of the Prostate (epLaVaRP) using continuous-wave 2μm Thulium Laser in patients suffering from Lower urinary tract symptoms (LUTS) caused by bladder outlet obstruction (BOO) with a wish of preserving ejaculation.
Methods:
We prospectively evaluated the results of epLaVaRP in 53 consecutive patients, aged 25 to 75years, medium 59y, with ability of ejaculation and wishing to preserve it, suffering from surgically indicated treatment of BOO from 2.2008 to 2.2010 with a maximal long term follow up of 24 months. The surgical procedure is performed by retrograde Vaporesection of middle lobe finishing 1 cm proximal of verum montanum and followed by a latero-apical incision and semilunar laser cuttings of the lateral lobes with preserving the paracollicular tissue.
The study terms included Prostate size by transrectal ultrasound, Urodynamic study, duration of hospitalization, postoperative catheterization and the registration of laser energy application.
The postoperative results are controlled by resected prostate weight, change of maximum flow rate, post void residual volume, IPSS and LQI, the ejaculation is evaluated by a questionnaire using Q 9 and 10 of the IEEF 15. Complications and re-intervention rate are recorded.
Results:
All patients were hospitalized for 4 days, catheterization time was 3 days. The mean prostate volume preoperatively was 32ml [minimum: 10; maximum: 85], the resected prostate weight without calculation of vaporized tissue (+ 1/3 of weight) was 8,45g [2; 37]. Energy application per treatment was evaluated with 69542 J [15320; 189369]. Urodynamic parameter showed clinically significant improvement: Mean flow rate (ml/s) increased from 7,31 to 24,87 and 30,7 (16,6; 47,4) in the long time follow up. Mean post void residual (ml) decreased from 183,73 to 10,91, IPSS and LQI improved from 20,74 to 5,60 and 4,56 to 1,70 respectively. Ejaculation was preserved in 82%. There was no stress urinary incontinence detected. A re-intervention was necessary in 2 cases (bladder neck sclerosis). Our diagnostic approach revealed detrusor overactivity in 6 patients preoperatively.
Conclusions:
The presented technique of Laservaporesection of the Prostate by using 2μm Thulium Laser is an effective and successful procedure to preserve ejaculation in endoscopic Prostate surgery.
By appreciation of the ejaculation preserving technique comes to mind the accuracy of the old concept of ejaculation physiology.